To attract as many members as possible, portals often attempt to offer comprehensive services. During the Internet boom, many portals derived the major portion of their revenue from advertisers targeting a particular audience. The situation changed when the marketing community discovered that advertising on Web pages was not as effective as they anticipated.³ As a consequence, advertising revenues for portals dropped precipitously. Many portal providers now are attempting to establish revenue streams from transactions, such as e-commerce, online CE or membership fees.

Today, many dentists are faced with the decision of whether to adopt a portal and, if so, which one. Choosing a portal is difficult because it is an essentially new product. No dental portal has been in existence for longer than six years, and most were developed in the last two to three years. In addition, the market for dental portals is highly volatile, and dominant players have not yet emerged.

A portal can provide a convenient way to satisfy dentists’ many needs. Accessing a single Web page to purchase practice supplies and equipment, take online CE courses, look for an associate or discuss clinical questions with colleagues can save time, effort and money. There are, however, hidden costs and risks associated with adopting a portal:

– the many differences in features and quality of portals are not evident at first glance, which can make making an informed choice difficult;

– adopting a portal means adding another Web page to one’s "favorites" or "bookmark" list;

– users must learn what functions it provides, how these functions work and how to navigate through it;

– since the portal is accessible only through the Internet, all components of the system such as the Web server, the connection through the Internet service provider, the modem/network connection and the end user workstation must work reliably⁴;

– the market for dental portals, like that for many other information technology services, is very immature and in constant flux, so dental portal companies are at a significant risk of going out of business or being acquired. If that happens, most or all of the effort, time and money invested in adopting the particular portal may be wasted.

We conducted this study to help dentists and their office personnel evaluate dental portals. While the study presents the results of a systematic evaluation of five dental portals, its emphasis is not on providing a Consumer Report–type aid for making an immediate decision. Our reason for conducting the study is to familiarize readers with important evaluation criteria to help them choose a portal. We tried to keep the time from evaluation to publication short; however, some of the information in this article is outdated. This is unavoidable owing to the nature of print publishing and makes being familiar with the evaluation criteria, rather than the evaluation itself, even more important.

	METHODS

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
In late 2000, we conducted a thorough search for Web sites that could be defined as dental portals. We examined review articles,^5,6 scanned dental Internet resource indexes,^7–10 used major search engines^11–13 and consulted several dental librarians involved in locating and evaluating dental Web sites. We performed a preliminary analysis on approximately 70 potential portal Web sites. Many of the Web sites no longer were active, had not been updated for a lengthy period or were pursuing a business model different from the one described in the original reference.

We finally selected five portals that were representative of the different types of services portals offer. While we could have selected many other Web sites, we limited our analysis to five portals so we could conduct an in-depth review of each. The dental portal sites were DentalTown, dentalxchange.com, E-Dental.com, Net32 and rdental.com (Table 1). None of the portals has been in operation for more than five years.

General. We obtained each portal’s contact information and length of time in business.

Services. We determined which of 14 services—product purchasing, online CE, practice management services, news, articles, online journals/magazines, dental practice Web pages, discussion forums/message boards, an event calendar, a directory of dentists, a job database, classified advertisements, an ask-the-expert feature for dentists and information for patients—each portal offered. For most services, we also collected detailed information such as the cost of a dental practice Web page. To compare representative product pricing between portals, we determined the prices for a basket of six common dental products or packages on Feb. 5, 2001.

Miscellaneous. We determined the presence and impact of advertisements, the contents of the privacy policy and the turnaround time for general and technical questions.

Navigation and usability. We assessed which search capabilities were provided on the site and rated navigation, color scheme and readability.

A low number of broken links/anchors is a sign that the Web site is well-designed and well-managed.

Site currency. We determined weekly whether the page was updated during the five-week rating period.

Site performance and responsiveness. We used a commercial Web server monitoring service, siteGuardian,¹⁴ to measure the site uptime of each portal. siteGuardian tried to contact each Web site every 30 minutes from a central monitoring server in South Carolina. In case of a failure, the service retried to connect to the Web site from a different location to minimize the chance that a local connectivity problem caused the failure. If the Web site still was unreachable, the service was recorded as being "down."

siteGuardian measured the Web sites’ response times by downloading a file of known size from the portals every 30 minutes. The download times are not directly comparable, but they do provide an indication of the speed of the connection between the monitoring station and each portal. The standard deviation, or SD, of the response times for a specific portal indicates of how consistent a portal performs. (These performance measures only approximate the true values, since download speeds on the Internet are influenced by a variety of factors.)

Site integrity. We measured how many broken internal links and anchors a Web site had. An anchor is a link within a single page (often used for headings within a page). A low number of broken links/anchors is a sign that the site is well-designed and well-managed. We used the commercial service Watchfire¹⁵ to scan up to 2,000 pages on each site and counted the number of broken internal links and anchors.

Evaluation. After several dental informatics experts reviewed the evaluation tool, we assigned the actual evaluation of each portal to a group of three to four dental students. These junior and senior students were participating in the elective course "Dental Informatics" at Temple University School of Dentistry during the spring semester of 2001. We had the students conduct the evaluations for two reasons. First, the students are somewhat representative of the group of dental practitioners who are likely to adopt and use a dental portal. Second, they were not involved in the development of the evaluation tool and had no economic interest in any of the companies or their evaluation.

Each group evaluated one portal for five weeks, kept a record of its findings and presented the results to the whole class at the end of the evaluation period. The only two categories that the groups did not evaluate were site performance and site integrity, since we used commercial monitoring services to automatically perform these evaluations.

	RESULTS

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
Services. Table 2 summarizes various services offered by each portal. Not all portals provided all services. DentalTown focused on product purchasing, a limited number of articles, and many services that center on community-building and interaction between dentists. Dentalxchange.com emphasized three large business areas—product purchasing, online CE and practice management services—and offered a significant number of other services. E-Dental.com provided a more limited set of services. Net32’s core focus was online versions of its publications Dental Economics, RDH and Dental Equipment and Materials. It has, however, added product purchasing and several other services. Rdental.com’s emphasis was online CE, but it is developing offerings in the practice management service area.

Product purchasing. Buying supplies and equipment over the Internet can save dental practices time and money through, for instance, comparison shopping. We found, however, that the three portals that offered products (DentalTown, dentalxchange.com and Net32) differed in the number of products in their databases, their approaches to searching for products and their pricing.

DentalTown did not provide a figure for the number of products in its database. Of the six dental products or packages in our product basket, we did not find four (Table 3). Visitors to the Web site could locate products in one of three ways: by navigating through a hierarchical menu of product categories, by searching for a stock-keeping unit or keyword, or by choosing from a vendor list. Unfortunately, the vendor list consisted mainly of dental supply houses, making the search for a product from a specific manufacturer difficult. Viewing detailed product information required free registration at the DentalTown Web site, the only portal to require registration.

Net32 listed more than 80,000 products and offered all six products in our product basket. Net32 provides prices as ranges, as its database contained price lists from many vendors (Table 3). Visitors to the site could locate products in a way similar to that of the dentalxchange.com site.

Online CE. Online CE is a rapidly growing market segment in dentistry.^16,17 Only dentalxchange.com and Rdental.com offered online dental CE. Dentalxchange.com offered approximately 100 courses. On average, the fee was $20 per credit hour for "standard" courses, which consist of text and occasional images and illustrations. The charge for "multimedia" courses, which combine slides, voiceover, images and text, was approximately $49 per credit hour. All courses listed the author, but none of them provided the date of creation. Rdental.com listed 13 courses on its Web site, and the price ranged from approximately $21 to $25 per credit hour. All courses listed author and date of creation.

Practice management services. Web-based practice management services are among the most recent technical offerings in dentistry, and they tend to be the most immature. Dentalxchange.com offered several types of services, including practice management, online eligibility and benefit determination, and transaction processing, which includes such services as electronic claims submission and electronic predetermination. Many of the services dentalxchange.com offers still are evolving, as is the case with rdental.com. Dentalxchange.com recently purchased DentiSoft, a provider of desktop and Web-based practice management systems. Rdental.com’s main offering is TigerView, a document/image transfer and management utility.

Other services. As Table 2 shows, the portals offered many other services. All of the portals provided articles, and four offered news stories; DentalTown did not publish news articles. Net32 referenced news stories through online versions of its print publications. The number of news stories released by the portals ranged from nine to 24 within a week and from 44 to 66 within a month.

DentalTown, dentalxchange.com and rdental.com offered to set up dental practice Web pages. Such Web pages often were developed based on templates that dentists chose. Prices varied based on the number of pictures and advanced features of the desired Web site. Some companies offered to register unique Internet domain names⁴ such as "www.drjohnsmith.com" for customers, while others hosted the Web site on their own Web server (resulting in a Web address such as "www.portal.com/drjohnsmith/"). Prices for dental practice Web pages are shown in Table 4. DentalTown’s dental practice Web pages are free, but they were the most basic offered by all of the portals.

All of the portals offered an event calendar. The quality of calendars depends on the number of events listed and the ease of finding particular events of interest. All of the portals for which we could determine the number of events listed more than 150 upcoming events. Overall, the search functions were flexible in the number of parameters that could be used to find an event.

Three portals (DentalTown, dentalxchange.com and Net32) provided a directory of dentists. Such directories may be useful for patients wishing to locate a dentist or for dentists wishing to locate a colleague. We could not determine the number of dentists in DentalTown’s database; however, searching made it clear that the data were not checked, as the database contained duplicate and invalid entries. Dentalxchange.com stated that its database contained 14,000 entries that could be searched for a variety of criteria, such as distance to a ZIP code, dentist’s specialty, insurance carriers accepted and languages spoken. Rdental.com provided a dental directory with similar search functions plus one for patient’s needs.

The portals also provided services such as job databases, classified advertising, ask-the-expert features for dentists and information for patients. The quality of the services varied widely. One job database used a commercial job search service that did not break out dental positions separately. While the service claimed to have a large number of positions on file, it almost was unusable for locating dental industry positions. Some collections of classified advertisements had such a low number of ads that they essentially were worthless.

Other portal features. The scope and depth of services are not the only characteristics that can be used to determine the usefulness of a portal site. Portals also need to be easy to use, easy to read and searchable. The site operator should respond to questions in a timely manner, and advertisements should not detract from the purpose of the site.

In general, we found that navigability, color scheme and readability were good or excellent across portals (Table 5). The only exceptions were DentalTown, for which we rated navigability as weak, and rdental.com, for which we split the rating between weak and good. Only E-Dental.com and rdental.com had basic and advanced Web page search features. Many users often go straight to the search feature on a site when it is present.¹⁸ Thus, it is somewhat surprising that large sites such as dentalxchange.com and Net32 did not provide this function.

All of the portals had privacy policies, all of which indicated that the company would not disclose individual data. Some policies did state that they would not release data to third parties unless legally required to do so or that they would only release aggregate data. None of the portals sold or rented its mailing list to other entities.

Site performance, responsiveness and integrity. Site performance, responsiveness and integrity values are shown in Table 6. Site uptime measures the percentage of time a Web site is accessible; for example, a site with an average uptime of 99 percent would be inaccessible approximately 14 minutes per day. Uptime is measured as a long-run average, which in our case was from Jan. 30, 2001, to April 5, 2001. We measured uptime for each Web site, as well as Web pages generated by a database such as product catalog pages.

The percentage of broken internal links and broken anchors also is shown in Table 6. Generally, the portals had a relatively low number of broken links and anchors. The exceptions were Net32 (1.8 percent broken anchors) and rdental.com (1.08 percent broken links and 1.08 percent broken anchors).

	DISCUSSION

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
This study comparatively evaluated five dental Internet portals. It showed that the portals offered a wide range of services whose completeness and quality differed widely. Four of the portals offered the majority of the 14 types of services reviewed. The more services a portal offered, the closer it came to the ideal of the "one-stop shopping" Internet site for dental professionals. But how close it came to that ideal also depended on how well these services were implemented. We found wide variation in the quality of implementation. How useful a specific portal was also depended on the user’s goal. It may be reasonable to use different portals for different purposes. The user, however, must be willing to invest additional effort to learn how each of the selected portals works.

When purchasing products over the Internet, three criteria are of initial importance: the number of products available, the ease of finding a specific product and the price. Dentalxchange.com offered approximately 20,000 products, and Net32 offered more than 80,000; the numbers supplied by the vendors are not audited. DentalTown did not provide a figure for the number of products it offered, and we could not find four of the six common products in our product basket on its database. In addition, finding a specific product quickly was difficult, and prices tended to be at the higher end of the range. Dentalxchange.com and Net32, thus, seemed to be the most useful sites for purchasing dental products.

Only two portals (dentalxchange.com and rdental.com) offered online CE. Dentalxchange.com offered a large number of courses. Dentists interested in online CE, however, have a myriad of options. Universities, dental manufacturers and consumer product companies collectively offer a large number of courses. Dentists looking for a CE course for reasons beyond simply fulfilling CE credit requirements probably should consult other sources in addition to portals.

Online practice management services still are in an early stage of development, and practitioners may want to wait until the offerings have matured somewhat. Such systems can replace the desktop-based systems that are used widely in dentistry. Online systems can be beneficial, but they have several disadvantages, such as limited functionality and a high dependence on the network connection.¹⁹ Other services, such as discussion forums, event calendars, dental directories, job databases and classified advertisements ranged from not at all useful to moderately useful. One of the discussion forums did not attain a critical mass of participants and discussion traffic. Most event calendars offered access to only a small fraction of available events for a particular time span and region. All of the dental directories contained only a small percentage of dental practitioners and sometimes were limited to the registered members of the sponsoring portal.

Alternatives were available for some practice management services. For instance, the ADA’s member directory (accessible to the public through ADA.org) contains information about approximately 144,000 ADA-member dentists. ADA.org also has member-accessible event calendar that within a few months of launching included a large number of entries.

The value of a particular portal is not enhanced significantly by services that are badly implemented and obviously not central to the portal’s business model.

	CONCLUSION

TOP ABSTRACT METHODS RESULTS DISCUSSION CONCLUSION REFERENCES

 
Portals are here to stay as a service in dentistry. This article presents only a snapshot of a rapidly evolving industry. Dental practitioners, therefore, can expect significant developments and changes in the coming years.

View larger version (90K): [in this window] [in a new window]   Dr. Schleyer is an associate professor and the Director, Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh, 3501 Terrace St., Pittsburgh, Pa. 15261, e-mail "Titus{at}pitt.edu". Address reprint requests to Dr. Schleyer.

View larger version (94K): [in this window] [in a new window]   Dr. Spallek is an assistant professor, Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh.